Provider Demographics
NPI:1891862801
Name:NISONGER, ELAINE PATRICIA (RDN, LD)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:PATRICIA
Last Name:NISONGER
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:MISS
Other - First Name:ELAINE
Other - Middle Name:PATRICIA
Other - Last Name:COOMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9713 CHISIK CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8785
Mailing Address - Country:US
Mailing Address - Phone:907-694-4274
Mailing Address - Fax:907-694-4274
Practice Address - Street 1:9713 CHISIK CIR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8785
Practice Address - Country:US
Practice Address - Phone:907-694-4274
Practice Address - Fax:907-694-4274
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK140133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK140OtherDIETITIAN LICENSE
AK210317OtherDMA CERTIFICATION NUMBER
AK918893OtherRD ID NUMBER